Chung Kim DDS, Inc

Primary specialty

DentistTaxonomy code 122300000X

License

23935 Issued in CA

Legal business name

CHUNG KIM DDS, INC

Practice address

180 E 4TH St
Suite a
Perris, CA 92570-2125

Phone

(951) 657-3102

Fax

(951) 657-7783

NPI assigned

May 17, 2007

Last updated

Apr 17, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Chung Kim, DDSNPI 1124170717

Title

President

Phone

(951) 657-3102

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Chung Kim, D.D.S.

  • Dentist
  • Perris, CA
  • NPI 1124170717
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366156800000",
    "number": "1376750307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 E 4TH ST",
            "address_2": "SUITE A",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925702125",
            "telephone_number": "951-657-3102",
            "fax_number": "951-657-7783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 E 4TH ST",
            "address_2": "SUITE A",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925702125",
            "telephone_number": "951-657-3102",
            "fax_number": "951-657-7783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHUNG KIM DDS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2013-04-17",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "CHUNG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-657-3102",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "23935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Perris, CA
• Providers in Perris, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.